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The Panic/Agoraphobia Therapy Program

by Thomas A. Richards, Ph.D., Psychologist

Panic and agoraphobia are some of the worst emotions that a human being can ever experience. Panic brings up feelings of dying, fears of losing control, and fears of completely going crazy. Many times these fears are accompanied by feelings of complete hopelessness and helplessness. People experiencing their first panic attack feel they are about to die, in many cases. Panic is a very real, chronic condition, that responds well to active cognitive-behavioral emotive therapy. People with panic disorder and agoraphobia can learn, through therapy, how to get better, step by step, until panic attacks no longer occur.

Goal: To overcome the vicious cycle of panic, anxiety, avoidance, fear, and depression.

1. First, we cut off the panic attacks by giving people the control they need to stop them. We use a combination of proven methods, techniques, and strategies that help develop the feeling of being in control that it takes to stop the panic attacks. We use gentle cognitive-behavioral therapy, which research indicates is the most effective and fastest way to overcome panic, with or without agoraphobia. The therapy requires the persons’ active cooperation.

2. Then, we work on the anxiety that causes the physical symptoms that go along with panic. The physical symptoms differ from individual to individual (e.g., heavy, uncomfortable chest; nausea; choking sensation; dizziness; heart palpitations, breathing, etc.) It is essential that even though people can prevent themselves from going into an attack, that they learn to deal with these symptoms and are able to eradicate them.

When people have enough control to stop the panic attack itself, but continue to have one or two nagging, negative physical symptoms, then two things can happen if this is left untreated: (1) at some later point in life, as a result of a stressful trigger, the panic attacks recycle and come back again with its original force, or (2) the "panic" gradually evolves into a syndrome that closely matches the clinical definition of generalized anxiety disorder. It is imperative that the person with panic follows through with CBT past the point that their panic attacks are cut off. This is called "overlearning" by researchers. The brain must "overlearn" the cognitive strategies that prevent panic attacks from happening. Thus, not only must the panic attacks go, but we must make sure that THE SYMPTOMS surrounding the attack LEAVE PERMANENTLY, TOO.

I have seen too many people who no longer experience panic "attacks", but now have a fairly constant level of anxiety and nervousness most all the time. This situation is not an improvement over panic and agoraphobia. It is simply trading one anxiety disorder for another. DON'T DO IT. Without the threat of attacks, the person falls into a state of constant worrying, thus having the symptoms of generalized anxiety disorder or GAD.

Stick with your CBT until all the physical symptoms are gone, and eventually you can test them out with your CBT therapist successfully.

Be persistent -- do not give up too early. Remember, CBT is a relatively short-term therapy -- don't try to shorten it down so much that you risk recycling panic or developing GAD. It is vitally important in the panic/agoraphobia area that all the therapy becomes "overlearned". If it is overlearned (i.e., it becomes a conditioned habit in the emotional brain), then panic cannot recycle or redirect toward GAD.

Overlearn, overlearn, overlearn.....don't stop until you're sick and tired from the repetition of the therapy......! You do not want panic attacks to come back. It's better to take some time to make sure you have cut them off forever.

3. We make sure the cognitive-behavioral therapy is "overlearned" and thus, is literally "conditioned" into the brain so that the control over the panic and anxiety cycle becomes automatic, like a habit. This step is essential because panic has a tendency to recycle or come back later in life if it is not permanently stopped.

Success Rate: Researchers are reporting a very high success rate using cognitive-behavioral methods. We are experiencing similar rates of success for people who complete the panic/agoraphobic program.

What is our mission?

The anxiety problems are not taken seriously by many people within and without the professional fields. For example, it is quite common for people with panic to have spent years and years and thousands of dollars in pursuit of an answer to these painful, very real, traumatic attacks. Our distinct specialty is to work with people with anxiety disorders. Our psychologists and staff members have suffered with anxiety disorders and know what it’s like to experience these life-restricting problems themselves When you come to the Anxiety Disorders Clinic, you don’t have to worry that your therapist will understand what you’re saying. We do understand the severity and pain of these conditions and therefore we use the latest research strategies to help you grow less and less anxious and more and more in control of your own life.

Potential Problems

Some people with panic tend to drop out of the program when their panic attacks have stopped and they feel they have control over them. This is a big mistake because stopping the panic attacks alone is never enough. The anxiety and thought processes that accompany panic must also be reconditioned into the brain and made permanent and automatic. The danger is that panic recycles or tends to reoccur throughout the lifetime. Unless CBT is completed so that we can prevent panic from recycling, we do not consider a person’s panic and anxiety successfully treated, despite the temporary improvement.

Cognitive-Behavioral Therapy for Anxiety

Cognitive-behavioral therapy is an active therapy. We work on methods, strategies, and techniques that gradually reduce and eliminate panic and anxiety. Each method is practiced at home when the person feels relatively OK, and is always stress-free, peaceful, and positive. The therapy takes about thirty minutes of practice per day. The key to success is persistence. People that seriously practice these techniques and methods each and every day make very nice and quick progress.

Number of sessions: Cognitive-behavioral therapy for panic allows for a a shorter number of sessions because you are asked to do therapy work at home that reinforces the cognitive material you learn in your session. Because each person is individual, however, no number is written in stone. People who have had longstanding panic over a period of decades typically need more attention.

To be successful, we need to develop that physiological change in the brain so that the new thoughts and feelings you learn become permanent and automatic. People who actively participate in the therapy, and are determined to "overlearn" the strategies, move along more quickly and experience stronger results.

Groups: To reinforce the therapy and to meet other people who are overcoming panic and agoraphobia, many people who finish individual therapy choose to participate in the panic therapy group. We do not mix groups of people with different anxiety problems. That is, everyone in your group will also be someone who has lived with panic-anxiety and is in the process of overcoming it. For panic, a group is not absolutely essential, but does serve as a powerful adjunct to therapy. Participants usually feel strengthened and more confident as a result of meeting with similar others and sharing solutions that they have found.

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Our History and Our Mission

The Anxiety Network began in 1995 due to growing demand from people around the world wanting help in understanding and overcoming their anxiety disorder. The Anxiety and Stress Clinic and its website, The Anxiety Network, received so much traffic and requests for help that we found ourselves spending much of our time in international communication and outreach. Our in-person anxiety clinic has grown tremendously, and our principal internet tool, The Anxiety Network, has been re-written and re-designed with focus on the three major anxiety disorders.

The Anxiety Network focuses on three of the major anxiety disorders: panic disorder, generalized anxiety disorder, and social anxiety disorder.

The Social Anxiety Institute, the largest site on the internet for information and treatment of social anxiety, has maintained an active website since 1998. Continuous, ongoing therapy groups have helped hundreds of people overcome social anxiety since 1994.